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    শরীফ উল কবীর
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    The document discusses criteria for admission to an intensive care unit (ITU) and presents three patient cases. It notes that an ITU has one available bed, with the next bed 5 hours away. While ITU doctors aim to admit patients who are potentially recoverable and could benefit from close observation or invasive treatment not available on a ward, other factors actually determine admissions. The document questions how to decide which of the three patients presented should be admitted given the limited bed availability. It suggests referral criteria alone has not worked and advocates for consultant-to-consultant referrals that clearly state the request and potential patient benefit from ITU admission.

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    Presentation 2 - Dr David Southern

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    The document discusses criteria for admission to an intensive care unit (ITU) and presents three patient cases. It notes that an ITU has one available bed, with the next bed 5 hours away. While ITU doctors aim to admit patients who are potentially recoverable and could benefit from close observation or invasive treatment not available on a ward, other factors actually determine admissions. The document questions how to decide which of the three patients presented should be admitted given the limited bed availability. It suggests referral criteria alone has not worked and advocates for consultant-to-consultant referrals that clearly state the request and potential patient benefit from ITU admission.

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    17 views26 pages

    Presentation 2 - DR David Southern

    Uploaded by

    শরীফ উল কবীর
    The document discusses criteria for admission to an intensive care unit (ITU) and presents three patient cases. It notes that an ITU has one available bed, with the next bed 5 hours away. While ITU doctors aim to admit patients who are potentially recoverable and could benefit from close observation or invasive treatment not available on a ward, other factors actually determine admissions. The document questions how to decide which of the three patients presented should be admitted given the limited bed availability. It suggests referral criteria alone has not worked and advocates for consultant-to-consultant referrals that clearly state the request and potential patient benefit from ITU admission.

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    of 26

    Dr David Southern

    Consultant in Anaesthesia & Intensive Care

    Wrexham Maelor Hospital


    What is Intensive Care ?

    A service for patients :


    • With potentially recoverable conditions
    • Who can benefit from
    • more detailed observation
    • Or more invasive treatment
    • Who cannot be adequately managed in general ward areas
    Patient 1
    20yr old girl has prolonged tonic-clonic seizure
    Proven grade 4 glioblastoma
    Assisted with all activities of daily living

    ?
    Potentially recoverable condition

    Who can benefit from


    more detailed observation
    Or more invasive treatment

    Cannot be managed on ward


    Patient 2
    80yr old man
    Performs all ADLs unassisted
    Sudden onset pneumonia
    SpO2 85% on facemask , RR 35, dyspnoeic

    ?
    Potentially recoverable condition

    Who can benefit from


    more detailed observation
    Or more invasive treatment

    Cannot be managed on ward


    Patient 3
    65yr old man
    Elective aortic aneurysm
    12L blood loss
    Unsuccessful surgery- patient still bleeding
    BP 70/40, HR 140, pale, ventilated, acidotic

    ?
    Potentially recoverable condition

    Who can benefit from


    more detailed observation
    Or more invasive treatment

    Cannot be managed on ward


    I have only ONE bed in ITU

    Next available bed = Preston


    5 hour return transfer time
    ITU doctors already working at maximum capacity
    So what do I do

    ?
    With apologies for plagiarism
    Its hard to get into ITU in Wales
    Getting a Patient Admitted to ITU
    • What we Intensivists like to think happens
    Factors determining ITU admission
    Getting a Patient Admitted to ITU
    • What we Intensivists like to think happens
    • What actually happens
    0 1 2 3

    Sessions of training
    So who would you admit ?
    Patient 2
    80yr old man, performs all ADLs unassisted
    Sudden onset pneumonia, SpO2 85% on facemask , RR 35, dyspnoeic

    ITU reduces immediate mortality by 6%

    Some hospitals admit (a) 2% of patients with pneumonia


    (b) 86% of patients with pneumonia

    ITU admission causes N0 increase in cost of hospital stay


    And after admission, the facts change
    80yr old man, performs all ADLs unassisted
    Sudden onset pneumonia, SpO2 85% on facemask , RR 35, dyspnoeic

    Worsening function over 12 months

    Recent discharge from another hospital


    And what do you do with the other 2 patients ?
    Is there a different approach ?
    Getting a Patient Admitted to ITU
    • What we like to think happens
    • What actually happens
    • The way forward
    Admission Criteria hasn’t worked
    ITU referral :best practice
    Consultant-Consultant referral is best : don’t delegate to juniors

    Be clear what you are asking for : do you want


    - admission to ITU
    - an ITU specialist to confirm that admission inappropriate

    Try to be objective about what benefit the patient will get from ITU

    What are the patients wishes


    Over to you

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